Polocrosse Association of New South Wales

Funding Application form

Title of event: ______

Applications must be received at least 14 days prior to the PANSW AGM

Name of event
Date of event / Start: Finish:
Event venue and/or location
Contact person / Mr / Mrs / Ms / Dr
Surname: First name:
Position held:
Contact points / Business phone
Mobile
Email
Postal Address

EVENT DETAILS

Description of event

Include information if this is a new or existing event

Funding amount requested: / $

What is the purpose of the event?

Are you applying for any other funding for this event? Yes No

If yes, please provide details of funding sought and from whom

Are there any other significant events that you know of taking place in the same time frame/location?

If yes, please provide details and advise of any linkages

EVENT OBJECTIVES

Ensure that you highlight the following:

·  how the event promotes participation in polocrosse

·  how the event provides a focal point for membership building and engagement.

·  how the event will assist in growing skills of the players

ak this is more your area than mine

Please describe how your event meets the relevant objective:

ORGANISING COMMITTEE CAPACITY

Describe the capacity and/or experience of your committee to deliver the event by providing examples of governance arrangements (eg. Structure, sub-committees, working groups), or other events/activities that demonstrate the committees capacity to successfully undertake this event.

EVENT ATTENDANCE

Please outline to the best of your ability the anticipated attendance at your event.

Participants and officials / Spectators
Origin / Number / Duration (in hours/days/
nights) / Number / Duration (in hours/days/
nights)
Local
Other area NSW
Interstate
Australia - Total
International
GRAND TOTAL

EVENT OUTPUTS:

Please enter information about who will benefit from this project

Target group/beneficiary:

Benefit to participants:


EVENT OUTCOME:

What is the longer term benefit to the sport, community or industry?

Describe what will be achieved at the completion of the event and any strategies that will be used to sustain the results.

EVENT PARTNERS:

If your event involves other partner organisations, please provide the following details for each organisation in the partnership:

Organisation
Contact name
Phone
Email
Role in partnership
Contribution to project

*Repeat table if multiple partners are involved.


BUDGET

Please note: Applicant contribution can include voluntary labour, sponsor contributions, use of existing facilities and equipment. Administration costs should be covered by the applicant.

Funding
Funding requested from PANSW
Confirmed funding from other sources (eg. PAA)
Sub-total (A)
Income (e.g. applicant’s contribution, sponsors, donations, fees and charges, in-kind contribution, etc)
Sub-total (B)
Expenditure – List all related costs by line item (eg. venue hire, security, first-aid, event infrastructure, marketing and communication expenses, etc.)
Sub-total (C)
Budget Surplus or deficit

REPORTING

If granted the Applicant will supply to PANSW within 14 days after the event a written report that ensures it states how it reached the outcomes listed above and of a nature that can be printed in a publication to be distributed to the public. Failure to do so may result in any future Applications made for the event or by the Applicant being denied.
DECLARATION BY APPLICANT

Declaration

1.  I certify that the information given in this application is true and correct.

2.  I agree to provide a written report as stated above to PANSW within 14 days of the event.

Print name
Signature
Position
Date

Please forward to:

Polocrosse Association of NSW

Telephone: 0407 207 649

Email:

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